CLC helps mothers of babies born with unique medical challenges

The anticipated challenges of feeding an infant born with unique medical conditions can seem insurmountable. But Noel Wier, BSN, RN, CLC and her colleagues at a level IV NICU in Colorado are helping moms with babies born with special challenges prove that they can and do breastfeed with proper support and determination.

Wier developed an appreciation for breastfeeding while breastfeeding her own four children and through working in the natural food industry for 18 years. Having experienced the “vibrant health” and bonding that breastfeeding gifted her, Wier’s inspired to help others.

“I feel really passionate about helping other moms on their journeys,” Wier says.

A unique patient population

In her work, Wier encounters patients with multifactorial challenges; some with genetic or structural abnormalities, drug dependencies, perinatal brain injuries, among other things. Many of the babies undergo multiple surgeries during their stay, and some patients stay in the hospital until their first birthday.

“We’re coming at infant feeding from so many different directions,” she says. “We see some of the sickest babies in Colorado and the surrounding four to five states.”  

Wier usually works with about 50 patients per day alongside a multidisciplinary team of many specialists, nurses and lactation care providers.

Wier serves families experiencing very high stress levels; even so, she and her team manage to help integrate human milk and breastfeeding into their care.

Surely the use of human milk and breastfeeding is always encouraged, but  Wier makes clear that because of the unique challenges mother baby couplets in the NICU face, there isn’t a focus on the “insistence to breastfeed”. Instead, they work to find the most appropriate feeding method.  

“I’m always amazed and inspired by the determination of some of our moms to provide milk for their babies,” Wier says. “There are moms who completely defy the odds.”

Defying the odds

One such example is that of a teenage mother of a baby born with gastroschisis, a birth defect where the abdominal contents come through the abdominal wall. Wier explains that babies born with gastroschisis are generally born via c-section to limit the risk of the exposed tissue being ripped or torn through the birth canal.

Once the baby is born, the abdominal contents are usually wrapped in what is essentially a plastic bag to keep them moist, and over time the baby undergoes surgery to relocate the tissues.

Despite this trying situation, the mother of this baby announced that she wanted to breastfeed and committed to pumping and storing her milk until her baby was ready to try breastfeeding directly.

First, the baby’s gut was slowly primed with mother’s milk through tube feedings. Then baby was placed skin-to-skin at a ‘dry’ or pumped breast. After only three days though, this baby started latching on to mother’s breast. By day five, the baby was nursing completely and went home breastfeeding exclusively.

In another success story, a baby with neurological damage ended up exclusively breastfeeding too. This child was sedated and placed on a cooling blanket for its first 72 hours of life to stop brain bleeding and decrease inflammation. The baby’s nutrition was provided through an IV while mother pumped. The baby then transitioned to nasogastric feedings of mother’s milk. Eight days later, the mother and baby enjoyed skin-to-skin at a dry breast.

“Mom was so excited to start breastfeeding,” Wier remembers. Her baby sucked well on a pacifier, but the baby had difficulty transitioning to latching at the breast.

“Mom was getting really stressed out,” Wier recalls after having tried different positioning, placing baby to breast while asleep, among other things. Ultimately, they resorted to a breast shield which turned out to be the proper tool at the proper time. The baby latched on immediately and continued to nurse well.

“It’s hard to put into perspective,” Wier begins reflecting on this couplet’s experience. “Mom was super stressed out and hadn’t necessarily bonded with baby… Baby had been sedated and [inhibited] in their natural ability to start nursing, so it just takes extra time and extra patience, but it ended up becoming quite a success story.”

Profound transformations

Wier goes on to share the story of a mother of twins born at 28 weeks gestation with minor twin-to-twin transfusion syndrome, a condition where abnormal blood vessel connections form in the placenta and cause blood to flow unevenly between the babies. The mother also suffered from high anxiety and other psychological issues.

Her twins were intubated immediately after birth, fed via IV and put on ventilators.

“It was hard for her when the babies were in the incubators,” Wier says. “She didn’t want to touch them because she thought that she would hurt them.”

Even suffering from high stress, the mother started pumping soon after delivery and around the clock every three hours. She helped with oral care, swabbing colostrum into her babies’ mouths and sometimes putting her colostrum on pacifier tips.

The larger twin took to breastfeeding first, while the smaller baby took longer to orally feed.

“Mom was able to establish breastfeeding with the first baby, then she could start working with the next baby,” Wier reflects. Both babies went home breastfeeding and bottle-feeding pumped milk.

Wier considers the profound impact of successful breastfeeding: she  says she watched this mother go from a position where she felt like she couldn’t touch her babies without hurting them, to a place where she felt empowered to advocate for herself and feel confident about the health care choices she made for her children.

Recharging with self-care

Wier and her colleague’s work is highly emotional, and their work is only effective if they have the means to engage in proper self-care. Wier has participated in Caritas Council programming which encourages self-care for nurses. She also says that running serves as her therapy.

“If a whole shift is too much, I usually sort it out in my runs,” she shares.

Wier finds it healing to be around her own family and her dog, participating in “everyday stuff” and enjoying her children who don’t suffer from health issues.

Debriefing in these moments allows Wier to give everything she has to the babies she’s responsible for in the NICU.

Find out more about the importance of human milk and breastfeeding in the NICU here.

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